Q. What is changing this year for consumers who have access to employer-backed health care?

Alvord: Starting in 2014, all plans, both employer-based and individual policies, cannot impose an annual cap on coverage or exclude coverage of care associated with the treatment and management of pre-existing conditions. Plans cannot impose varied premium rates based on gender, and plans must provide coverage for the Essential Health Benefits, such as emergency services, maternity care and prescriptions.

(A list of "Essential Health Benefits" can be found at healthcare.gov/what-does-marketplace-health-insurance-cover).

The employer mandate, which requires businesses with more than 50 full-time employees to offer health insurance, has been delayed a year and will now not be required until Jan. 1, 2015.

Some small businesses may still decide to investigate or purchase their insurance through the Small Business Health Options Program exchange (SHOP) in their state, even though the mandate and penalty has been delayed. If your employer decides to go this route, you will be guided to the SHOP website where you can finalize your plan selection.

Q. Should consumers with employer-backed health care take a look at the health exchange, even though they likely won't qualify for a tax credit?

A: If you are looking to switch plans, you may shop on the marketplace/exchanges during the open enrollment period for an alternate plan. However, you will forfeit any premium assistance that is contributed by your employer currently, and will most likely not be eligible for the financial assistance programs offered through the marketplace if your coverage is considered affordable.

(If the cost of a plan from your employer that would cover you — and not any other members of your family — is less than 9.5 percent of your household income for the year then the plan is considered affordable).

In the exchange or marketplace in your state, you can go through the application process and see the plan benefits and pricing options before committing to enroll, so there is no downside to checking out your options.

Do keep in mind, however, that your employee contribution to the employer-offered coverage, is often excluded from income for federal and state income tax purposes, thus, often lowering your tax liability each pay period. Your payments for coverage through the marketplace are made on an-after tax basis.

Q. What options are there for someone whose costs are increasing exponentially?

A: If you are researching plans and coverage options for you and your family, it is definitely wise to evaluate and compare your options on the marketplace, even if you ultimately end up securing insurance through another avenue. Education and research will help you make the best decision for you and your family.

It is important to note that the only way you may receive the new financial assistance options such as tax credits or cost-sharing subsidies to get lower costs for your health coverage based on income is by purchasing your insurance through the marketplace.

Open enrollment for Virginia's Health Insurance Marketplace began Oct. 1 and will continue until March 31 this first year. To begin coverage in a marketplace plan on Jan. 1, you must complete your enrollment prior to Dec. 15. In future years, the open enrollment period will be from Oct. 15 to Dec. 7, unless you meet one of the qualifications that make you eligible for special enrollment periods.

Q. What trends are you seeing in employer-backed health care? Who benefits? Who loses out?

A: In general, employers are continually evaluating their insurance offered to employees to provide the best balance of benefits and cost (to both the employer and employee) including changing insurance carriers and adjusting the employee out-of-pocket costs, including both monthly premiums and cost share structures. Some employers are also shedding retiree coverage offerings as well as not offering coverage for spouses and dependents that have coverage options available through other sources.

To be an educated insurance consumer (and employee), we encourage everyone to be familiar with the insurance products offered by their employer, whether they remain consistent from previous years or new insurance products are introduced at your workplace.

Q. What are the most important aspects of a plan to understand in order to make a good choice for your family?

A: The selection of the appropriate health insurance plan is an important task that requires some preparation on the part of the consumer. To best compare and research the various plan options you have you might first consider the following:

• First, it will be important to evaluate your medical needs today and moving forward. Take time to consider your current medical situation and that of your family, including your family risk factors and health history and any potential health concerns you may need addressed. This will help you determine which medical services are important for you to have covered by insurance. This includes knowledge of medication needs as well as specific doctors or treatment facilities that are required in your care.

• Second, it will be important to look at your personal finances and establish a budget for health care-related costs. Determine how much you are willing, or able, to pay each month to support your health care needs, factoring in any eligible discounts or financial assistance that may be available. Don't forget to include potential co-payments, deductibles and co-insurance you may incur when using your health insurance benefits including visits to physicians, hospitals and other medical facilities in your calculations. If you know you are likely to see a doctor regularly, it might be worth paying a higher monthly premium cost to have lower responsibility of out-of-pocket costs associated with each doctor visit or procedure.

Once you have a sense of your important medical needs and the amount you can afford, you will begin your comparison of plan benefits.

Things that are helpful to consider when comparing plans are the pharmacy and medication formulary, the network of doctors and providers in your area, the annual deductible and any special restrictions on coverage or exclusions that they plan may have. You may also review the consumer and professional ratings of the insurance companies within your top few plans to get a better understanding of the quality of these companies.

Q. What are some resources to research this further?

A. Some great tools to help with your understanding and comparison of plans include a glossary of insurance terms located at aarp.org/health/affordable-care-act.

Those with cancer or a high risk of cancer can use the Cancer Insurance Checklist that will help them evaluate specific areas of plan benefits that are significant for cancer expenses during treatment at cancerinsurancechecklist.com.

Consumer Reports put together a guide that helps you read and compare the Plan Summary and Benefits form that provides details on each plan option. It is important to take note of specific elements of the plan to ensure you are aware of the possible costs associated with the plan, including deductibles, copayments, exclusions, and more. The guide can be found at consumerreports.org/health.

You can find more information about the Patient Advocate Foundation and contact experts for help at patientadvocate.org.